Waivered MAT Inquiry - Affinia Health Network

Waivered MAT Prescriber Inquiry

This inquiry is for the BCBS all-payer Medication Assisted Treatment (MAT) initiative. Our goal with this initiative is to improve patient access to care and outcomes for patients with opioid use disorder (OUD)/ substance abuse disorder (SUD) through the establishment of a team-based care support system from waivered PCPs and specialists. With this waiver, a provider may prescribe buprenorphine to patients with OUD/SUD (initiative does not cover alcohol use disorder [AUD], pain, weight loss, fatigue, or non-OUD/ non-SUD indications for these medications). With the goal of expanding the team-based MAT approach, we would like to know which offices or providers currently offer MAT services. We would also like to know which offices or providers may be interested in offering MAT. Thank you.

What is the name of your practice site?*
Please fill out one survey for each site location/name. Thank you.
Which providers at your practice are currently waivered AND prescribing MAT?*
Last Name First Name Credential(s)

Please enter one line for each provider. To add additional provider(s) click the plus sign next to the credential box. Please enter NA in the Last name field if this does not apply to your practice site.
Which providers at your practice are currently waivered, but NOT prescribing MAT?*
Last Name First Name Credential(s)

Please enter one line for each provider. To add additional provider(s) click the plus sign next to the credential box. Please enter NA in the Last name field if this does not apply to your practice site.
Which providers at your practice are interested in providing MAT, but are not currently waivered?*
Last Name First Name Credential(s)

Please enter one line for each provider. To add additional provider(s) click the plus sign next to the credential box. Please enter NA in the Last name field if this does not apply to your practice site.
Have any of the following barriers prevented providers at the site from prescribing or expressing interest in prescribing MAT? Check all that apply:*
- Unsure about how to identify and/or treat Opioid Use Disorder.
- Unsure what Medication-Assisted Treatment (MAT) is.
- Unsure about how to obtain a DATA 2000 (buprenorphine/Suboxone®) waiver.
- Uncomfortable offering Medication-Assisted Treatment (MAT) in my office.
- Not enough time in my clinical schedule to offer Medication-Assisted Treatment (MAT) in my office.
- Lack of colleague support to offer Medication-Assisted Treatment (MAT) in my office.
- No barriers at this time
If you have additional thoughts or comments (including barriers not mentioned above), please document them here. Thank you.

Last Name	First Name	Credential(s)

Last Name	First Name	Credential(s)

Last Name	First Name	Credential(s)